Search Images Maps Play YouTube News Gmail Drive More »
Sign in
Screen reader users: click this link for accessible mode. Accessible mode has the same essential features but works better with your reader.

Patents

  1. Advanced Patent Search
Publication numberUS20060149306 A1
Publication typeApplication
Application numberUS 11/330,661
Publication dateJul 6, 2006
Filing dateJan 12, 2006
Priority dateOct 20, 2001
Also published asUS7052454, US20040054353
Publication number11330661, 330661, US 2006/0149306 A1, US 2006/149306 A1, US 20060149306 A1, US 20060149306A1, US 2006149306 A1, US 2006149306A1, US-A1-20060149306, US-A1-2006149306, US2006/0149306A1, US2006/149306A1, US20060149306 A1, US20060149306A1, US2006149306 A1, US2006149306A1
InventorsCharles Hart, Scott Taylor
Original AssigneeApplied Medical Resources Corporation
Export CitationBiBTeX, EndNote, RefMan
External Links: USPTO, USPTO Assignment, Espacenet
Sealed surgical access device
US 20060149306 A1
Abstract
A surgical access device is adapted to facilitate access through an incision in a body wall having an inner surface and an outer surface, and into a body cavity of a patient. The device includes first and second retention members adapted to be disposed in proximity to the outer surface and the inner surface of the body wall, respectively. A membrane extending between the two retention members forms a throat which is adapted to extend through the incision and form a first funnel extending from the first retention member into the throat, and a second funnel extending from the second retention member into the throat. The throat of the membrane has characteristics for forming an instrument seal in the presence of an instrument and a zero seal in the absence of an instrument. The first retention member may include a ring with either a fixed or variable diameter. The ring can be formed in first and second sections, each having two ends. Couplings can be disposed between the ends to accommodate variations in the size of the first retention member. The first retention member can also be formed as an inflatable toroid, a self-expanding foam, or a circumferential spring. A plurality of inflatable chambers can also provide the surgical access device with a working channel adapted for disposition across the body wall. A first retention member with a plurality of retention stations functions with a plurality of tethers connected to the membrane to change the shape of the membrane and the working channel. A stabilizing platform can be used to support the access device generally independent of any movement of the body wall.
Images(21)
Previous page
Next page
Claims(6)
1-23. (canceled)
24. A combination for facilitating a surgical procedure on a patient supported on a surgical table, comprising:
an access device including a membrane defining a working channel adapted for disposition across a body wall of the patient to provide instrument access into a body cavity of the patient;
a stabilizing platform supporting portions of the access device generally independent of any movement of the body wall; and
the stabilizing platform having a base in a fixed relationship with the surgical table, and a cross member in a fixed relationship with the portions of the access device.
25. The combination recited in claim 24, further comprising:
at least one arm extending between the base and the cross member.
26. The combination recited in claim 25, wherein at least one arm has a pivotal relationship with the base.
27. The combination recited in claim 26, wherein the cross member has an axis and is rotatable on its axis relative to the arm.
28. The combination recited in claim 25 wherein at least one arm is releasably attached to the base.
Description
    CROSS REFERENCE TO RELATED APPLICATIONS
  • [0001]
    This is a non-provisional application claiming the priority of provisional application Ser. No. 60/241,953 filed on Oct. 19, 2000, entitled “Hand-Assisted Laparoscopy Apparatus and Method”, as well as the PCT application serial no. PCT/US01/29682, filed on Sep. 21, 2001, and entitled “Surgical Access Apparatus and Method,” both of which are fully incorporated herein by reference.
  • BACKGROUND OF THE INVENTION
  • [0002]
    1. Field of Invention
  • [0003]
    This invention relates generally to surgical access devices, and more specifically to access devices adapted for use in minimal invasive surgery to provide sealed instrument access across a body wall and into a body cavity.
  • [0004]
    2. Discussion of Related Art
  • [0005]
    Surgical access to a body cavity, such as the abdominal cavity, is referred to as “open laparotomy” or “closed laparoscopy.” An open procedure involves an incision of sufficient size to allow a surgeon to place hands and instruments within the surgical site. In addition, the site must be open enough for the surgeon to clearly see what he or she is doing. There is often a need for multiple retractors, clamps, and sponges. All of these devices compete for room within the surgical site.
  • [0006]
    Laparoscopic or closed surgery eliminates many of the issues surrounding open laparotomy. In a typical pressurized laparoscopy, the abdominal wall is punctured and at least one trocar is inserted into the peritoneum. Gas is introduced into the abdominal cavity and to elevate the abdominal wall away from the internal organs. This results in a large, clear operating field. Additional trocars can be inserted as needed for various procedures. A laparoscope is used to provide visualization of the surgical site. The instrumentation for laparoscopic procedures has developed prolifically in recent years and the surgeons have become comfortable with a “remote-control” approach to various aspects of surgery. Cutting, dissecting, cauterizing, stapling and suturing have all been addressed by laparoscopic device manufacturers.
  • [0007]
    Despite the many advantages of laparoscopic surgery, there remain a few complex procedures that make laparoscopy difficult or risky. In some of these cases, a hybrid procedure makes the most sense. If one could have the visibility and open field of a laparoscopic procedure and the control of an open procedure, one would truly have it all. However, the two modalities tend to obviate each other. Indeed, there are some who would argue that the advances of laparoscopy would be in vane if an open procedure were added as a default.
  • [0008]
    In recent years, a few enterprising surgeons have advanced a method that they call “hand-assisted” laparoscopy or “handoscopy.” This involves placing one of the surgeon's hands inside the patient through an enlarged incision, while under laparoscopic visualization. With no protruding instrumentation normally used in closed laparoscopy, it is not required to perform overly challenging maneuvers
  • [0009]
    The challenge now facing the surgeon in this procedure is providing an adequate sealing means within the enlarged incision. The surgeon's hand must be comfortable, properly placed and free to move with a normal range of motion. In addition, the surgeon should be able to remove and replace his/her hand into the abdominal cavity without loss of pneumoperitoneum.
  • [0010]
    Several devices have been proposed in an attempt to satisfy the requirements of the “handoscopist.” They generally involve an elastomeric seal that fits through an incision and is held in place by retention means on either or both sides of the abdominal wall. The devices are generally complex and require several steps to place. One of the devices requires an adhesive to be placed on the exterior abdominal wall (skin) as the seal is adhered to the skin. This requires not only application of the adhesive but also a drying time. Allergic reactions and other complications must be considered when using this product. Another device makes use of a “toroidal balloon” that inflates to position the device and seal the incision. The surgeon must overcome the friction and sealing pressure of this device when inserting and withdrawing his/her hand from the surgical site. A further device involves the use of a built-in glove or sleeve. This arrangement diminishes the range of motion and the tactile sensation of the hand.
  • [0011]
    U.S. Pat. No. 5,848,992 discloses a surgical access device that allows the conversion of an open procedure to a laparoscopic procedure. In addition, the '992 patent discloses the use of such a device in a case where a large organ is to be removed. In this instance, an incision of adequate size is made initially and sealed with the device at the same time the trocars are being inserted
  • [0012]
    Notwithstanding these proposed devices, there remains a continuing need for a surgical access device that provides a flexible, simple and complete seal within an incision of adequate size for introduction of a human hand.
  • SUMMARY OF THE INVENTION
  • [0013]
    The present invention satisfies the requirements of a surgical access device for use with surgical instruments including the surgeon's hand. With this access device, “hand-assisted” laparoscopy is greatly facilitated within a closed surgical environment.
  • [0014]
    The present invention makes use of an internal retention member and an external retention member connected by a flexible, lubricious material. At least one of the retention members is tensionable to provide adequate stability to the incision site.
  • [0015]
    The present invention also provides a sealing portion that allows the largest range of hand motion without leakage of insufflation gas. The seal is formed of a material that responds well to the presence of glove material such as Natural Latex, Poly-isoprene, Nitrile, Vinyl or Polyurethane.
  • [0016]
    In one aspect of the invention, the surgical access device is adapted to facilitate access through an incision in a body wall having an inner surface and an outer surface, and into a body cavity of a patient. The device includes a first retention member configured to surround the incision in proximity to the outer surface of the body wall. A second retention member is configured to surround the incision in proximity to the inner surface of the body wall. A membrane extending between the first retention member and second retention member forms a throat adapted for disposition through the incision. A first funnel extends from the first retention member into the throat and a second funnel extends from the second retention member into the throat. The throat of the membrane has characteristics for forming an instrument seal in the presence of an instrument, any zero seal in the absence of an instrument.
  • [0017]
    In another aspect of the invention, the first retention member comprises a ring having a first section with a first end and a second end, and a second section with a third end moveable relative to the first end to the first retention member and a fourth end moveable relative to the second end of the first retention member. A coupling is disposed between the first end of the first retention member and the third end of the second retention member. This coupling is operable to vary the distance separating the first end and the third end to control the shape of a working channel formed by the membrane. A second coupling or a hinge may be provided between the second end of the first retention member and the fourth end of the second retention member.
  • [0018]
    In a further aspect of the invention, the first retention member has a shape that is variable to control the shape of the working channel formed by the membrane. The first retention member can be formed as an inflatable structure such as a toroid. The first retention member may also include self expanding foam for a circumferential spring.
  • [0019]
    In still a further aspect of the invention, a surgical access device can include a plurality of inflatable chambers each extending in a plane passing through the axis of the device. These chambers collectively define a working channel that is adapted for disposition across the body wall. The chambers may have a straight or U-shaped configuration.
  • [0020]
    In another aspect of the invention, the device includes a first retention member including a ring with a plurality of retention stations. The membrane is attached to a plurality of tethers that can be coupled to the ring at an associated one of the retention stations to provide the membrane with a desired shape.
  • [0021]
    In still a further aspect of the invention, a stabilizing platform is proposed to support the access device generally independent of any movement associated with the body wall.
  • [0022]
    These and other features and advantages of the invention will become more apparent with a description of preferred embodiments in reference to the associated drawings.
  • DESCRIPTION OF DRAWINGS
  • [0023]
    FIG. 1 is a side view drawing of a surgical patient in a laparoscopic procedure;
  • [0024]
    FIG. 2 is a front view drawing of a surgical patient in a “hand-assisted” surgical procedure;
  • [0025]
    FIG. 3 is a front view drawing of a preferred embodiment of the present invention in place;
  • [0026]
    FIG. 4 is an oblique view drawing of the present invention showing two retention members;
  • [0027]
    FIG. 5 is an oblique view drawing of the invention in an alternate embodiment;
  • [0028]
    FIG. 6 shows the present invention having an alternate exterior retention member;
  • [0029]
    FIG. 7A illustrates a folded retention member of the present invention in a closed condition;
  • [0030]
    FIG. 7B illustrates the folded member in an opening condition;
  • [0031]
    FIG. 7C shows the folded member in a half open condition;
  • [0032]
    FIG. 7D shows the folded member in a fully open condition with the seal material tensioned;
  • [0033]
    FIG. 8A illustrates an alternate embodiment of the folded retention member closed;
  • [0034]
    FIG. 8B illustrates the alternate embodiment partially open;
  • [0035]
    FIG. 8C shows the half open retention member having a transverse seal opening;
  • [0036]
    FIG. 8D shows the transverse seal opening fully tensioned along its length;
  • [0037]
    FIG. 9 shows an adjustable external retention member opening the seal portion;
  • [0038]
    FIG. 10 shows the adjustable retention member with a seal portion under minimum tension;
  • [0039]
    FIG. 11 illustrates an adjustable retention having a hinge and jackscrew combination;
  • [0040]
    FIG. 12 shows the hinge and jackscrew placing opening tension on the seal member;
  • [0041]
    FIG. 13 shows the retention member having two jackscrew adjustments and having the seal member in a transverse position and under minimum tension;
  • [0042]
    FIG. 14 shows the retention member where the seal member is under maximum tension;
  • [0043]
    FIG. 15 illustrates an embodiment of the retention member wherein the tensioning of the seal member is provided by detente folding spacers;
  • [0044]
    FIG. 16 shows the detente spacers in an over-center or locked position and applying tension to the seal member;
  • [0045]
    FIG. 17 is an oblique view of the external retention member having a ratchet for holding the seal member at a preferred tension;
  • [0046]
    FIG. 18 illustrates an alternate embodiment of the present invention wherein the external retention member is an un-inflated but inflatable or fillable hollow torrus;
  • [0047]
    FIG. 19 shows the inflatable retention member fully inflated and tensioning the sealing member to provide sealing pressure;
  • [0048]
    FIG. 20 illustrates the present invention having two un-inflated but inflatable retention members and the seal member at minimum tension;
  • [0049]
    FIG. 21 shows the two inflatable retention members fully inflated and the seal member fully tensioned;
  • [0050]
    FIG. 22 illustrates an alternate embodiment of the present invention where the un-inflated retention members and the seal portion are integrally formed of connected tubular segments;
  • [0051]
    FIG. 23 shows the alternate embodiment in an inflated condition and shaped as would be the case if the device were inserted within a surgical incision;
  • [0052]
    FIG. 24 illustrates an alternate embodiment wherein the external retention member is a coil spring;
  • [0053]
    FIG. 25 illustrates the alternate embodiment wherein the external and the internal retention members are coil springs;
  • [0054]
    FIG. 26 illustrates an alternate embodiment of the present invention wherein a strap is used to maintain a position over a surgical incision;
  • [0055]
    FIG. 27 illustrates an embodiment of the present invention wherein preferred embodiments of the retention member and the seal member are held in place by a strap;
  • [0056]
    FIG. 28 illustrates an additional preferred embodiment of the present invention wherein the sleeve/membrane has tensioning tethers in a first condition;
  • [0057]
    FIG. 29 illustrates the tethers in a second condition;
  • [0058]
    FIG. 30 illustrates the tethers in an irregular, non-uniform configuration;
  • [0059]
    FIG. 31 illustrates the tethers in a regular, uniform configuration; and
  • [0060]
    FIG. 32 is a perspective view of an access device in combination with a stabilizing platform.
  • DESCRIPTION OF PREFERRED EMBODIMENTS AND BEST MODE OF THE INVENTION
  • [0061]
    In FIG. 1, a patient is illustrated in a prone or supine position and designated by the reference numeral 10. The patient 10 has an abdomen 12 which includes a body or abdominal cavity 16 defined by an abdominal wall 18. A plurality of trocars 20, 21, and 22 are placed so as to provide surgical access to the abdominal cavity 16. Various instruments 23, 24, 25 are illustrated for use through the trocars 20, 21, and 22.
  • [0062]
    In FIG. 2, a “hand-assisted” laparoscopic procedure is shown. The patient 10 is supine and the abdominal cavity 16 is insufflated. In addition to the trocars 20, 21, and 22, there is an additional surgical access device 50 that has been placed relative to a surgical incision 100. This access device 50 is adapted to receive a hand 160 of a surgeon, as it is placed through the access device 50 and into the abdominal cavity 16 of the patient 10. The surgeon is able to use the inserted hand 160 to perform tasks that are too difficult or not safe for the instruments normally used in laparoscopy. The access device 50 provides a gas tight seal so that the insufflated, pressurized abdomen at cavity 16 does not collapse. The access device 50 may also accommodate large, contaminated specimens or diseased organs or tissue. Furthermore, instrumentation or tools that might otherwise be too large for a trocar may be introduced through the access device 50 and subsequently attached to device drivers operated through the trocars 20, 21, and 22. Specimen bags that are introduced through a trocar may be removed through the access device 50 when fully burdened.
  • [0063]
    The access device 50 is placed through the surgical incision 100, FIG. 3, and retained against the external abdominal wall 17 by a first retention member or retainer 55, and against the internal abdominal wall 18 by a second retention member or retainer 65. The external, first retainer 55 supports a gas tight sleeve or membrane 75 at a first end 76. The internal, second retainer 65 supports the gas tight sleeve or membrane 75 at the second, opposite end 86. The two opposing ends 76 and 86 maintain a communicating surface 77 that passes through the incision 100. The material of the surgical access device 50 provides a durable and non-permeable surface against the incised tissue defining the incision 100.
  • [0064]
    With particular reference to FIGS. 4, 5, 6, a preferred embodiment of the access device 50 has a first end 51, a second end 52 and a communicating middle portion 53. The first end 51, in a preferred embodiment, is external to a body cavity 16 and comprises an enlarged and adjustable portion 55. The exact shape of the first end portion 55 may be circular, ovoid, rectangular, square, triangular or the like. The first end portion 55 is sized and configured to be adjustable in area so that a surface 77 of a sleeve or membrane 75 is appropriately stretched or tensioned.
  • [0065]
    A preferred embodiment of the access device 50 employs an overlapping leaf spring 56 that is biased to the open condition. As opposing ends 57, 58 of the spring 56 spread apart, appropriate tension is exerted upon the sleeve/membrane 75. The applied tension causes a pulling force to be exerted through the communicating middle portion 53. This force approximates the second, internal, or distal end 52 of the access device 50 to the inner surface of the abdominal wall 18.
  • [0066]
    The second retaining portion 65 is preferably constructed of a flexible material that allows it to be inserted into the surgical incision 100 in a folded form or reduced profile. The second retaining portion 65 is preferably self-deploying or, at least, has sufficient memory to return to a preferred, somewhat circular, or pre-determined shape or condition without manipulation. The material choices for such a configuration may include flexible vinyl, rubber, silicone, or other elastomeric. The materials may also include rigid materials like rigid plastic or metal with a hinged or flexible portion.
  • [0067]
    In addition, the construction of either the first or second retention members 55 and 65, respectively, may include the use of elastomeric components that have been fitted with or have been molded to include shape memory metals, such as Nickel-Titanium (NiTinol). In any case, the second retention member 65 is easily deformable to a condition or shape that facilitates introduction into the smallest possible surgical incision 100. It must be kept in mind that the second retention member 65 must be sized and configured to retain the access device 50 in place during the rigors of an active surgical procedure, and do so without causing tissue damage such as tissue necrosis or abrasion. A preferred embodiment of the second retention member 65 comprises a ring 66 of soft silicone or vinyl with an internal, encapsulated or insert molded Nickel-Titanium support ring. This embodiment may be introduced in a very deformed condition and will subsequently recover the preferred shape and size upon completion of introduction into the body cavity 16.
  • [0068]
    As an alternative, the super-elastic and shape-memory properties of Nickel-Titanium may be drawn from temperature transition properties of the alloy. For instance, the second retention member 65 may be cooled to a temperature where the ring 66 is easily, deformable to a high degree, then, as the alloy warms to body temperature, the retention member 65 returns to a programmed shape, size or configuration.
  • [0069]
    The sleeve/membrane portion 75 is shaped by the tension between the first retention member 55 and the second retention member 65. The sleeve/membrane 75 may initially define an orifice 78 which may be a slit or a hole or the like that communicates between the exterior and the interior of the body cavity 16 through a lumen 80. The lumen 80 exhibits a first condition when the sleeve/membrane 75 is not under tension and a second condition when the sleeve/membrane 75 is under tension.
  • [0070]
    In a preferred embodiment, the tensioning of the sleeve/membrane 75 adjusts the lumen 80 to a preferred size and configuration. Such a configuration might be the creation of the radiused, funnel-shaped orifice 78 transitioning to the smaller diameter in the middle portion 53 and again transitioning to a funnel-shaped enlargement 67 distally at the second retention member 65.
  • [0071]
    The material of a preferred embodiment of the sleeve/membrane 75 may include a non-distensible or non-elastic material such as polyethylene, polyurethane or reinforced elastomeric. The choice of polyethylene for the sleeve/membrane 75 provides the surface 77 with nearly friction-free characteristics against most glove materials. Since the polyethylene material is non-elastic, the sleeve/membrane 75 will fold into discrete “fan-fold” segments 79. Such a condition will allow the material of the sleeve/membrane 75 to be compressed radially by the adjacent body tissue so that it forms a throat 90 or nearly occluded middle portion 53 when no hand or instrument is present within the lumen 80 of the device 50. Thus, in the absence of the hand or instrument, the throat functions as a zero seal. When a hand or instrument is present within the lumen 80, the fan-folded material at the throat 90 of the sleeve/membrane 75 yields to the size and shape of the inserted hand or instrument yet forms an occlusive instrument seal. Bearing in mind that the normal pneumoperitoneum is about 0.18 to 0.28 psi, the throat 90 of the present invention is adequate to form both the zero seal and the instrument seal.
  • [0072]
    The embodiment of FIG. 5 is similar to that of FIG. 4 except that the membrane 75 in proximity to the first retention member 55 has the configuration of a septum. In this case, the orifice 78 is formed as a slit which transitions into the throat 90 of the device. Fan-fold segments 79 extend to the ends of the slit or orifice 78 in this embodiment of FIG. 5. These fan-fold segments 79 are absent in the embodiment of FIG. 6.
  • [0073]
    With reference to FIGS. 7A-D, a preferred embodiment of the surgical access device 50 of the present invention comprises a first retention member 155 that is folded so that it resembles a taco. The folding of the first retention member 155 relaxes the member 75, allowing the second retention member 65 to be easily inserted into a surgical incision 100 (FIG. 2). The subsequent unfolding of the first retention member 155, for example, by forcing apart a pair of separable members 156, 157, results in a stretching of the sleeve/membrane 75. In this position, the two members 156, 157 of the first retention member 155 are locked in a single plane or flattened condition with the sleeve/membrane 75 in tension.
  • [0074]
    In a preferred embodiment of the folded first retention member 155 the orifice 78 is elongate and in line with a fold 159 of the sleeve/membrane 75 as well as a pair of hinged portions 158 of the first retention member 155. In an alternative embodiment illustrated in FIGS. 8A-8D, the orifice 78 that is elongate and transverse to both the fold 159 of the sleeve/membrane 75 and the hinged portions 158 of the first retention member 155.
  • [0075]
    With reference to FIGS. 9-17, a surgical access device 50 is shown with the first retention member 155; however, in this case the member 155 is adjustable in area or circumference. In this embodiment, the two separable members 156, 157 of the first retention member 155 may be separated along a common plane by a pair of actuating adjusting sleeves 200, 220 operating against adjusting screws 210, 230. This action will place the sleeve/membrane 75 under tension so as to prepare the orifice 78 for use. There may be a several of the adjusting members 200, 220, for example, two, three, four, or more, that cooperate to stretch the sleeve/membrane 75. This stretching may be uniform or non-uniform.
  • [0076]
    Specifically referring to FIGS. 11, 12, a further embodiment of the surgical access device 50 is shown to have at least one hinge 260 that permits the separate members 156, 157 to pivot on each other in opposing directions upon application of a spreading force. In this case, the spreading force is applied by rotation of a jackscrew and thumb-wheel combination 265. The resulting non-uniform spreading force causes the orifice 78 to assume a preferred condition.
  • [0077]
    With reference to FIGS. 13, 14, there is shown another embodiment of the surgical access device 50 according to the present invention wherein the elongate orifice 78 is positioned so as to be stretched along its lengthwise midline 278. This configuration causes the orifice 78 to assume a more closed natural condition than would be the case wherein the elongate orifice 78 is transverse to the stretching moment. A combination of in-line and transverse stretching of the sleeve/membrane 75 and the orifice 78 can result in a more symmetrical or uniform opening of the orifice 78.
  • [0078]
    Referring now to FIGS. 15, 16, another embodiment of the surgical access device 50 is shown, according to the present invention. In this embodiment the separable members 156 and 157 are moveable in a single plane between an expanded position illustrated in FIG. 15 and a contracted position illustrated in FIG. 16. In this case, the separable member 156 has ends 161 and 163 while the separable member 157 has ends 160 and 162. Folded separation members 285 and 296 are disposed between the ends 160, 161, and the ends 162, 163, respectively. In the compressed state of the separable members 156, 157, the separable members 285 and 296 are in a folded condition with the first ends 160 and 162 abutting the ends 161 and 163, respectively. When the separable members 156 and 157 are spread to the expanded state illustrated in FIG. 15, these separation members 285 and 296 are moved to an unfolded, flattened or over-centered condition as illustrated in FIG. 16. In this condition, the separation members 285 and 295 maintain the separable members 156 and 157 in the expanded state thereby stretching the membrane 175.
  • [0079]
    An elongate orifice 78 may be orientated either in-line or transverse to the direction of stretch. An additional embodiment of the surgical access device 50 may comprise a plurality of the foldable separation members 285, 296 wherein the stretching of the sleeve/membrane 75 is more or less uniform. The foldable separation members 285, 295 may be constructed of metal, with or without a discrete hinge, or plastic having either discrete or “living” hinges.
  • [0080]
    FIG. 17 depicts a further embodiment of the surgical access device 50 according to the present invention. In this case, the first retention member 155 comprises a length of rigid or semi-rigid material formed into a hoop or coil 290. This coil 290 has opposing ends 291 and 292 as well as an outer surface 293 and an inner surface 294. When the ends 291, 292 are spread relative to each other, the coil 290 assumes a larger diameter and area so that the tension upon the attached sleeve/membrane 75 is increased.
  • [0081]
    The position of the coil ends 291 and 292 can be maintained by a series of ratchet teeth 295 and an associated ratchet pawl 296. In the illustrated embodiment, the ratchet teeth 295 are formed on the outer surface 293 and the ratchet pawl 296 is formed on the end 292. Alternatively, a second series of ratchet teeth can be formed on the inner surface 294, and an associated second ratchet pawl can be formed on the end 291. This double-ended, double-sided ratchet configuration results in a very large distention potential for the first retention member 155 and, concomitantly, the sleeve/membrane 75.
  • [0082]
    In this embodiment, the first retention member 155, as well as the ratchet teeth 295, and the ratchet pawl 296, are preferably constructed of a rigid plastic material such as polycabonate, ABS, PBC or other filled or non-filled material. In a further embodiment, the first retention member 155 may be formed from a metal so that it is sterilizable and reusable. Such an embodiment may still include the disposable sleeve/membrane 75 and the second retention member 65.
  • [0083]
    With reference now to FIGS. 18, 19, 20, 21, a surgical access device 50 according to the present invention is shown having an inflatable or fillable first retention member 300, and a malleable, foldable or otherwise deformable second retention member 65. In a preferred embodiment, the inflatable or fillable retention member 300 comprises a closed, hollow structure 310 which may be circular or toroidal. The hollow structure 310, when un-inflated or un-filled exerts very little, if any, stretching or tensioning force upon the sleeve/membrane 75. When the hollow structure 310 is inflated, however, it assumes a larger diameter and area which results in the desired stretching or tensioning of the sleeve/membrane 75. Preferred embodiments of the hollow structure 310 can be formed from either elastic or non-distensible materials.
  • [0084]
    Similarly, the sleeve or membrane 75 can be formed from an elastic material although in a preferred embodiment the membrane 75 is non-distensible. In this embodiment, expansion of the hollow structure 310 also stretches the sleeve/membrane 75 so that the throat 90 of the access device 50 is also placed under tension. This tensioning of throat 90 which connects the first retention member 300 and the second retention member 65, causes the second retention member 65 to be appropriately drawn into sealing engagement with the interior surface of the abdominal wall 18 (FIG. 1). This will result in a gas-tight seal around the access device 50. In the embodiment of FIG. 19, the membrane 75 is in the form of a septum.
  • [0085]
    With attention drawn specifically to FIGS. 20, 21, there is shown a surgical access device 50 according to the present invention wherein a first retention member 300 includes the inflatable or fillable structure 310, and a second retention member 365 also includes an inflatable or fillable structure 375. The second retention member 365, when un-inflated or un-filled may be easily inserted through an incision 100 into a body cavity 16 and subsequently inflated or filled to assume a more-or-less rigid or definite shape and configuration within the body cavity 16. The first retention member 300 may then be inflated or filled to provide the external retention and the concurrent stretching or tensioning of the sleeve/membrane 75. Although it is apparent that the sleeve/membrane 75 can also be formed with a double wall structure that is inflatable, this is not the case with the embodiments of FIGS. 20 and 21. In these illustrated embodiments, the sleeve/membrane 75 that connects the two inflatable or fillable retention members 300, 365, is formed of a single layer or thickness of non-dispensable or non-elastic material. With this construction, the membrane 75 is not inflatable and relies on a minimum of intrusive material along the middle portion or throat 90 and through the incision 100. At this throat 90 of the access device 50, the sleeve/membrane 75 remains smooth, lubricious, thin, and non-bulky.
  • [0086]
    An additional embodiment of the access device 50 of the present invention is shown in FIGS. 22, 23 wherein an open-ended, generally cylindrical sleeve 450 is constructed of a plurality of axially aligned, communicating, hollow, inflatable, fillable members 455. The communicating members 455 are inflatable or fillable by means of an inflation tube 458. Particularly when uninflated, the generally cylindrical shape (FIG. 23) of the access device 450 may be easily distorted so that a distal end 460 may be placed through the surgical incision 100 and the abdominal cavity 16. As the access device 450 is inflated or filled, it assumes an “hour-glass” shape, and develops a first retention portion 470 and a second retention portion 480 joined by a middle section 490.
  • [0087]
    A non-distensible or non-elastic material is also stipulated for use in this preferred embodiment so that friction is minimized, and so that the material of the middle section 490 does not gather or fold as a gloved hand or large instrument is repeatedly inserted and withdrawn through the access device 450.
  • [0088]
    In the illustrated embodiment, the individual inflatable or fillable members 455 form axial chambers and abutments 495 which prevent material motion and also minimize surface contact between a gloved hand and the material which forms the seal with the abdominal wall 18. The lumen of the middle section 490 may be lubricated with a thick or viscous material which can be stored along the seams of the abutting or adjoining inflatable or fillable members 455. The lubricating product may also function to perfect the instrument seal in the present of a gloved hand or instrument, or to perfect the zero seal in the absence of the gloved hand or instrument.
  • [0089]
    With reference to FIG. 24, a surgical access device 50 according to the present invention is shown wherein a compressible helical coil member 500 forms a first retention member 550. The coil member 500 may be deformed so as to minimize the tension upon an attached sleeve/membrane 75 and a middle portion 560 thereof. A second retention member 565 may be deformed and placed within the surgical incision 100, so that upon release or decompression of the coil 500 of the first retaining member 550 the second retaining member 565 is appropriately approximated to the interior wall of a body cavity. For packaging and shipping, the coil 500 of the first retaining member 550 may be maintained within a containment pouch, bag, box, or the like (not shown) in its most-compact condition. In this condition, the first retaining member 550 will exert a minimum of tension upon the attached sleeve/membrane 75.
  • [0090]
    In a similar embodiment illustrated in FIG. 25, a second retaining member 563 is also provided with a second retention coil member 565. This second retaining coil member 565 may be introduced through the incision 100 in a compact configuration and subsequently released to assume an enlarged diameter. This provides the access device 50 with an increased area of contact at the inner surface of the abdominal wall 18. As the second retention coil 565 is released to assume its enlarged diameter, it also functions to stretch or tension the attached sleeve/membrane 75.
  • [0091]
    With reference to FIGS. 26, 27, there is shown a surgical access device 50 according to the present invention that is adapted to be held in position over the surgical incision 100 by, a strap or belt 600 which surrounds the abdomen 12 of the patient 10 (FIG. 1). In this embodiment, the access device 50 may include the strap or belt 600 and associated closure members or buckles 610. The access device 50 in the embodiment of FIG. 26 is illustrated as a septum seal 615. In the embodiment of FIG. 27, the access device is similar to that described with reference to FIG. 19 and designated with the reference numeral 300.
  • [0092]
    Turning now to FIGS. 28 and 29, the surgical access device 50 is shown with a membrane 75 extending between the first retention member 55 and the second retention member 65. In this embodiment, the first retention member 55 includes a solid, rigid ring 700 that is disposed in a plane generally perpendicular to the axis of the access device 50. On the side of the ring 700 opposite the second retaining portion 65, a plurality of slits 710 are provided which extend radially of the ring 700. In this embodiment, a plurality of tethers 715 are attached to the membrane 75 at different radial locations. The tethers 715 are attached to the membrane 75 at an inner end 16 and are provided with an enlargement feature 717 at an outer end 718. In this embodiment, the slits 710 of the ring 700 are sized and configured to engage and confine at least one of the tethers 715. In such an embodiment, the enlargement features 715 can act to prevent the tethers 715 from being drawn back through the slits 710. The enlargement feature 717 can also function as handles facilitating engagement of each of the tethers 717, as it is drawn outwardly through the associated slit 710 to tension the membrane 75.
  • [0093]
    In such an embodiment, it may be desirable to form the slits 710 so that they are tapered toward the bottom of the slit 710. This will facilitate compression of the associated tether 715 to increase the frictional engagement between the tether 715 and the ring 700. In this manner, the tethers 715 can be collectedly adjusted to provide the membrane 75 with the desired shape and seal characteristics. The membrane 75 can be released from the ring 700 by merely lifting the tethers 715 to disengage their associated slits 710. In FIG. 30, the tether 715 is tensioned non-uniformly to provide the membrane 715 with an irregular shape. This configuration can be compared with that illustrated in FIG. 31 wherein the tethers are tensioned uniformly to provide the membrane 75 with a uniform configuration.
  • [0094]
    In FIG. 32, the access device 50 is illustrated in combination with a stabilizing platform 800. Initially, it will be noted that the access device 50 which is illustrated, is that described generally with reference to FIGS. 28-31. However, it will be apparent that the stabilizing platform 800 can be adapted to receive and function with any of the foregoing embodiments of the access device 50, in order to achieve the advantageous discussed below.
  • [0095]
    In this embodiment, the stabilizing platform 800 includes a base having a generally planer configuration with a pair of support flanges 805 and 807 extending perpendicular on opposing sides of the base 803. A pair of upstanding arms 110 and 112 are pivotally, and perhaps releasably attached to the associated flanges 805 and 807. A cross member 814 is pivotally and perhaps releasably connected between the arms 810 and 812. This cross member 814 in a preferred embodiment is perpendicular to the arms 810 and 812 and parallel to the plane of the base 803. The access device 50 is supported by the cross member 814, with its axis 816 generally perpendicular to the cross member 814. With this orientation, the first retention member 855, represented by the ring 700, is disposed in a plane which may be pivoted relative to the upstanding arms 810, 812, as well as the base 803.
  • [0096]
    In operation, the base 803 is disposed beneath the patient 10 (FIG. 1) in contact with the back of the patient 10. The upstanding arms 810 and 812 can then be mounted to the flanges 805 and 807, respectively, on either side of the patient 10. The cross member 814 can then be attached to the arms 810 and 812.
  • [0097]
    The support platform 800 can be of considerable advantage in a hand-assisted laparoscopic procedure which requires that a human hand being inserted and withdrawn several times while maintaining the abdominal pressure or pneumoperitoneum. As noted, the sealing port or throat 90 (FIG. 4) of the access device 50 must tightly fit around the wrist or arm of the surgeon. When the hand of the surgeon is removed, the throat 90 must close tightly to form a zero seal. This closed sealing attachment to the hand or arm of the surgeon can cause the abdominal wall 18 (FIG. 1) to change in shape and particularly in elevation as the hand is inserted and removed. If the access device 50 is directly attached to the abdominal wall 18, this movement of the wall 18 can result in movement of the access device 50 causing other surgical instruments, such as a laparoscope, to be moved or displaced. It is the purpose of the stabilizing platform 800 to support the access device 50 independently of the abdominal wall 18. With this stabilization, movement of the surgeon's hand through the abdominal wall 18 will be less apt to move the access device 50. This greatly stabilizes the surgical field and particularly the instruments inserted through the access device 50. Appropriate pivoting of the cross member 814 and the arms 810 and 812 enable the access device 50 to be swiveled to a position appropriate to patients of various size and weight. In an alternative embodiment, the base may be formed as part of a surgical table with at least one support member, such as the arms 810, 812, extending from one or both sides of the patient to support the cross member 814.
  • [0098]
    Given the many embodiments disclosed herein for the access device 50, many other embodiments will now become apparent with changes in structure or materials. For that reason, one is cautioned not to limit the scope of the invention only to the disclosed embodiments, but only with reference to the following claims.
Patent Citations
Cited PatentFiling datePublication dateApplicantTitle
US2812758 *Jul 26, 1955Nov 12, 1957Blumenschein John CSurgical retractor
US2835253 *Aug 14, 1956May 20, 1958Florence W BorgesonSurgical appliance
US3244169 *Feb 17, 1964Apr 5, 1966Surgical DevicesViscera pouch
US3717151 *Mar 11, 1971Feb 20, 1973R CollettFlesh penetrating apparatus
US3729027 *Jan 26, 1972Apr 24, 1973Bare HFlexible tubing with integral end clamps
US3860274 *Jul 2, 1973Jan 14, 1975Richard L LedstromPipe coupling
US3970075 *Sep 30, 1974Jul 20, 1976Sindelar Frank JSurgical retractor anchor apparatus
US4024872 *Jun 1, 1976May 24, 1977Muldoon James PColostomy device and method
US4069913 *Aug 11, 1975Jan 24, 1978Harrigan Roy MajorSurgical glove package and fixture
US4083370 *Nov 3, 1976Apr 11, 1978Taylor John DBloat relief tube and holder
US4188945 *Aug 14, 1978Feb 19, 1980Triplus Sjukvardsprodukter AbSurgical cloth
US4254763 *Jun 7, 1979Mar 10, 1981Codman & Shurtleff, Inc.Surgical retractor assembly
US4254973 *Apr 30, 1979Mar 10, 1981Celanese CorporationFluid coupling seal
US4367728 *Sep 5, 1980Jan 11, 1983Mutke Hans GIsolation apparatus
US4369284 *Mar 28, 1980Jan 18, 1983Applied Elastomerics, IncorporatedThermoplastic elastomer gelatinous compositions
US4798594 *Sep 21, 1987Jan 17, 1989Cordis CorporationMedical instrument valve
US4802694 *Oct 26, 1987Feb 7, 1989Central Machine And Tool Co.Quick-disconnect coupling
US4895565 *May 16, 1988Jan 23, 1990Cordis CorporationMedical instrument valve
US4903710 *Jan 5, 1988Feb 27, 1990Jessamine John GSurgical isolation drapes
US4911974 *Jul 5, 1988Mar 27, 1990Toray Silicone Company, Ltd.Tack-free silicone gel moldings
US4926882 *Sep 6, 1988May 22, 1990Lawrence Sharon KTransparent shielding device for use with autopsy saw
US4984564 *Sep 27, 1989Jan 15, 1991Frank YuenSurgical retractor device
US4991593 *Jun 13, 1989Feb 12, 1991Minnesota Scientific, Inc.Flexible bag for storing body organs
US4998538 *Aug 25, 1989Mar 12, 1991Charowsky Deborah AMedical drape for laser surgery
US5015228 *Oct 4, 1990May 14, 1991Eastman Kodak CompanySterilizing dressing device and method for skin puncture
US5082005 *Dec 18, 1990Jan 21, 1992New England Deaconess HospitalSurgical access device
US5178162 *Apr 14, 1992Jan 12, 1993Bose William JSplash and spill resistant extremity irrigation and debridement surgical drape
US5189375 *Jun 4, 1991Feb 23, 1993United States Of America As Represented By The Secretary Of The ArmyInductive cable resistance tester
US5192301 *Sep 3, 1991Mar 9, 1993Nippon Zeon Co., Ltd.Closing plug of a defect for medical use and a closing plug device utilizing it
US5197955 *Oct 18, 1991Mar 30, 1993Ethicon, Inc.Universal seal for trocar assembly
US5207656 *Apr 19, 1990May 4, 1993Cordis CorporationMedical instrument valve having foam partition member
US5213114 *Oct 25, 1990May 25, 1993Bailey Jr Paul FOphthalmologic drape and method
US5299582 *Sep 16, 1991Apr 5, 1994Little Rapids CorporationSurgical isolation apparatus
US5316541 *Jan 19, 1993May 31, 1994Fischer William BEnclosure for surgical procedures
US5380288 *Mar 30, 1993Jan 10, 1995Innovasive Devices, Inc.Surgical cannula and trocar system and method of using the same
US5389080 *Mar 31, 1993Feb 14, 1995Yoon; InbaeEndoscopic portal for use in endoscopic procedures and methods therefor
US5389081 *May 18, 1993Feb 14, 1995United States Surgical CorporationStabilizer for a valve assembly for introducing instruments into body cavities
US5407433 *Feb 10, 1993Apr 18, 1995Origin Medsystems, Inc.Gas-tight seal accommodating surgical instruments with a wide range of diameters
US5480410 *Mar 14, 1994Jan 2, 1996Advanced Surgical, Inc.Extracorporeal pneumoperitoneum access bubble
US5486426 *Nov 28, 1994Jan 23, 1996Mobil Oil CorporationCold sealable cohesive polymer coated polyolefin substrate
US5492304 *Jun 16, 1993Feb 20, 1996United States Surgical CorporationSeal assembly for accommodating introduction of surgical instruments
US5496280 *May 19, 1994Mar 5, 1996Applied Medical Resources CorporationTrocar valve assembly
US5503112 *Jun 22, 1994Apr 2, 1996Land O'lakes, Inc.Method for selecting ruminant feed composition using abomasal infusion
US5508334 *Nov 15, 1993Apr 16, 1996Applied Elastomerics, Inc.Thermoplastic elastomer gelatinous compositions and articles
US5514133 *Aug 26, 1994May 7, 1996Golub; RobertAccess device for endoscopic surgery
US5518278 *Feb 13, 1995May 21, 1996Sampson; Gerald A.Coupling
US5603702 *Aug 8, 1994Feb 18, 1997United States Surgical CorporationValve system for cannula assembly
US5628732 *Jan 19, 1996May 13, 1997Ethicon Endo-Surgery, Inc.Trocar with improved universal seal
US5632284 *May 22, 1996May 27, 1997Graether; John M.Barrier eye drape and method of using same
US5709664 *Mar 1, 1996Jan 20, 1998Applied Medical Resources CorporationTrocar valve assembly
US5720730 *Sep 1, 1995Feb 24, 1998Blake, Iii; Joseph W.Lubricated trocar valve
US5728103 *Aug 23, 1996Mar 17, 1998Applied Medical Technology, Inc.Implantable subcutaneous access device and method of using same
US5741298 *Nov 26, 1996Apr 21, 1998Macleod; CathelMethod and devices for video-assisted surgical techniques
US5753150 *Mar 6, 1997May 19, 1998Johnson & Johnson Vision Products, Inc.Low oxygen molding of soft contact lenses
US5865729 *Oct 10, 1997Feb 2, 1999Olympus America, Inc.Apparatus for facilitating gynecological examinations and procedures
US5865807 *Jul 23, 1997Feb 2, 1999Blake, Iii; Joseph W.Seal for trocar
US5871474 *Apr 2, 1997Feb 16, 1999General Surgical Innovations, Inc.Screw-type skin seal with inflatable membrane
US5895377 *Feb 18, 1997Apr 20, 1999United States Surgical CorporationValve system for cannula assembly
US5899208 *Feb 28, 1997May 4, 1999Gaya LimitedHand access port
US5904703 *Nov 7, 1997May 18, 1999Bard ConnaughtOccluder device formed from an open cell foam material
US5906577 *Apr 30, 1997May 25, 1999University Of MassachusettsDevice, surgical access port, and method of retracting an incision into an opening and providing a channel through the incision
US6010494 *Mar 26, 1998Jan 4, 2000Disetronic Licensing AgConnection system for medical applications
US6024736 *Jul 29, 1997Feb 15, 2000General Surgical Innovations, Inc.Laparascopic access port for surgical instruments or the hand
US6025067 *Jun 14, 1997Feb 15, 2000Fay; John NicholasSoft elastomeric composite composition
US6033426 *Jul 24, 1998Mar 7, 2000Olympus Optical Co., Ltd.Access device for surgical treatment
US6033428 *Jan 26, 1999Mar 7, 2000Sardella; William V.Laparoscopic surgery device
US6035559 *Oct 9, 1996Mar 14, 2000Rotasole Pty. Ltd.Shoe with circular pad in the sole to relieve twisting stresses on the ankle
US6045535 *May 29, 1997Apr 4, 2000One Way Ocular Technology Ltd.Surgical sealing sleeve
US6053934 *Jun 2, 1998Apr 25, 2000Cook Urological, IncorporatedReplaceable, medical device handle
US6171282 *Jul 23, 1999Jan 9, 2001Edgar K. RagsdaleSoft cannula and methods for use
US6224612 *Apr 22, 1999May 1, 2001Scimed Life Systems, Inc.Atraumatic medical retrieval device
US6238373 *Jun 28, 1999May 29, 2001General Electric Innovations, Inc.Screw-type skin seal with inflatable membrane
US6382211 *Jul 21, 1997May 7, 2002Medical Creative Technologies, Inc.Surgical retractor liner appliance
US6383162 *Nov 12, 1999May 7, 2002Paul H. SugarbakerApparatus and method for abdomino-pelvic chemotherapy perfusion and lavage
US6533734 *Jun 9, 2000Mar 18, 2003The Board Of Trustees Of The University Of IllinoisTime-integrated sampler of bodily fluid
US6551344 *Jan 12, 2001Apr 22, 2003Ev3 Inc.Septal defect occluder
US6558371 *Jul 19, 2001May 6, 2003Karl Storz Gmbh & Co. KgApparatus for holding a trocar sleeve in different spatial orientations
US6702787 *Jun 6, 2002Mar 9, 2004Tyco Healthcare Group LpTrocar seal system
US6723044 *Mar 14, 2002Apr 20, 2004Apple Medical CorporationAbdominal retractor
US6846287 *Apr 29, 2002Jan 25, 2005Atropos LimitedSurgical device for retracting and/or sealing an incision
US6866861 *Jan 29, 1999Mar 15, 2005Land O'lakes, Inc.Method and composition for enhancing milk component concentrations
US6895965 *Mar 26, 2002May 24, 2005Respironics, Inc.Customizable seal, mask with customizable seal and method of using such a seal
US6997909 *Apr 22, 2003Feb 14, 2006The Children's Hospital Of PhiladelphiaLow profile combination device for gastrostomy or jejunostomy applications having anti-granuloma formation characteristics
US7033319 *Apr 20, 2004Apr 25, 2006Apple Medical CorporationAbdominal retractor
US7052454 *Oct 20, 2001May 30, 2006Applied Medical Resources CorporationSealed surgical access device
US20020002324 *Jun 1, 2001Jan 3, 2002Mcmanus Ronan BernardDevice for use in surgery
US20020038077 *Oct 23, 2001Mar 28, 2002General Surgical Innovations, Inc., California CorporationLaparoscopic access port for surgical instruments or the hand
US20030040711 *Oct 9, 2002Feb 27, 2003Racenet David C.Trocar seal system
US20040015185 *Sep 21, 2001Jan 22, 2004Ewers Richard C.Surgical access apparatus and method
US20040024363 *Apr 22, 2003Feb 5, 2004Goldberg Elizabeth A.Low profile combination device for gastrostomy or jejunostomy applications having anti-granuloma formation characteristics
US20040049100 *Feb 27, 2003Mar 11, 2004Atropos LimitedRetractor
US20040054353 *Oct 20, 2001Mar 18, 2004Scott TaylorSealed surgical access device
US20040073090 *Aug 6, 2003Apr 15, 2004John ButlerWound retractor
US20040092796 *Sep 22, 2003May 13, 2004John ButlerWound retractor system
US20050020884 *Aug 25, 2004Jan 27, 2005Hart Charles C.Surgical access system
US20050033246 *Aug 5, 2004Feb 10, 2005Ahlberg Russell E.Surgical device with tack-free gel and method of manufacture
US20050059865 *Sep 17, 2003Mar 17, 2005Applied Medical Resources CorporationSurgical instrument access device
US20050090717 *Oct 6, 2003Apr 28, 2005Frank BonadioWound retractor device
US20060030755 *Oct 5, 2005Feb 9, 2006Applied Medical Resources CorporationSurgical access apparatus and method
US20060047284 *Aug 25, 2004Mar 2, 2006Gresham Richard DGel seal for a surgical trocar apparatus
US20060054669 *Sep 16, 2004Mar 16, 2006Li-Chuan HsiehExpandable document bag
US20060084842 *Oct 7, 2005Apr 20, 2006Hart Charles CSurgical access system
Referenced by
Citing PatentFiling datePublication dateApplicantTitle
US7650887Jun 3, 2003Jan 26, 2010Applied Medical Resources CorporationWound retractor
US7678046 *Mar 16, 2010Ethicon Endo-Surgery, Inc.Hand assisted laparoscopic seal assembly with a ratchet mechanism
US7704207Oct 12, 2006Apr 27, 2010Applied Medical Resources CorporationCircular surgical retractor
US7727146Oct 12, 2006Jun 1, 2010Applied Medical ResourcesWound retractor with gel cap
US7736306Oct 12, 2006Jun 15, 2010Applied Medical Resources CorporationHand access laparoscopic device
US7749161Jul 6, 2010Ethicon Endo-Surgery, Inc.Hand assisted laparoscopic device
US7749415Jul 6, 2010Applied Medical Resources CorporationMethod of making a hand access laparoscopic device
US7766822 *Mar 6, 2007Aug 3, 2010Ethicon Endo Surgery, Inc.Hand assisted laparoscopic seal assembly with a ratcheting mechanism
US7815567Oct 12, 2006Oct 19, 2010Applied Medical Resources, CorporationSplit hoop wound retractor
US7867164Jan 11, 2011Atropos LimitedWound retractor system
US7878974Feb 1, 2011Applied Medical Resources CorporationHand access laparoscopic device
US7883461Feb 8, 2011Applied Medical ResourcesWound retractor with gel cap
US7892172Apr 27, 2010Feb 22, 2011Applied Medical Resources CorporationCircular surgical retractor
US7909760Oct 12, 2006Mar 22, 2011Applied Medical Resources CorporationSplit hoop wound retractor with gel pad
US7913697Mar 29, 2011Applied Medical Resources CorporationWound retractor
US7951076Oct 7, 2005May 31, 2011Applied Medical Resources CorporationSurgical access system
US7998068Aug 16, 2011Atropos LimitedInstrument access device
US8002786 *Mar 9, 2007Aug 23, 2011Ethicon Endo-Surgery, Inc.Hand assisted laparoscopic seal assembly with deflection feature
US8012088Aug 20, 2007Sep 6, 2011Atropos LimitedRetractor
US8016755Dec 3, 2010Sep 13, 2011Applied Medical Resources CorporationSurgical access apparatus and method
US8021296Sep 20, 2011Atropos LimitedWound retractor
US8070676Dec 6, 2011Applied Medical Resources CorporationSurgical access apparatus and method
US8105234Jan 31, 2012Applied Medical Resources CorporationSurgical access apparatus and method
US8109873May 12, 2008Feb 7, 2012Applied Medical Resources CorporationSurgical retractor with gel pad
US8118735Sep 26, 2007Feb 21, 2012Ethicon Endo-Surgery, Inc.Rotational control for a hand assisted laparoscopic seal assembly
US8157835Jun 1, 2010Apr 17, 2012Applied Medical Resouces CorporationAccess sealing apparatus and method
US8187177Nov 29, 2006May 29, 2012Applied Medical Resources CorporationSurgical instrument access device
US8187178May 29, 2012Atropos LimitedInstrument access device
US8226552May 12, 2008Jul 24, 2012Applied Medical Resources CorporationSurgical retractor
US8235054Feb 22, 2011Aug 7, 2012Applied Medical Resources CorporationWound retractor
US8257254Sep 4, 2012Tyco Healthcare Group LpLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US8262568Oct 13, 2009Sep 11, 2012Applied Medical Resources CorporationSingle port access system
US8267858Sep 18, 2012Applied Medical Resources CorporationWound retractor with gel cap
US8308639Mar 17, 2011Nov 13, 2012Applied Medical Resources CorporationSplit hoop wound retractor with gel pad
US8313431Oct 15, 2010Nov 20, 2012Applied Medical Resources CorporationSplit hoop wound retractor
US8317690Nov 27, 2012Covidien LpFoam port and introducer assembly
US8317691Apr 20, 2009Nov 27, 2012Atropos LimitedWound retractor device
US8323184Mar 8, 2010Dec 4, 2012Covidien LpSurgical access port and associated introducer mechanism
US8343047Jan 22, 2009Jan 1, 2013Applied Medical Resources CorporationSurgical instrument access device
US8357086 *Jan 22, 2013Applied Medical Resources CorporationSurgical instrument access device
US8375955Feb 19, 2013Atropos LimitedSurgical procedure
US8388526Mar 5, 2013Applied Medical Resources CorporationWound retraction apparatus and method
US8394018Dec 11, 2009Mar 12, 2013Covidien LpLaparoscopic instrument and trocar systems for transumbilical laparoscopic surgery
US8414487Apr 9, 2013Applied Medical Resources CorporationCircular surgical retractor
US8439831May 14, 2013Covidien LpLaparoscopic instrument and trocar system and related surgical method
US8449512 *Apr 9, 2010May 28, 2013Davinci Biomedical Research Products Inc.Stoma stabilitating device and method
US8460271May 13, 2010Jun 11, 2013Covidien LpLaparoscopic instrument and cannula assembly and related surgical method
US8480575Aug 28, 2012Jul 9, 2013Applied Medical Resources CorporationSingle port access system
US8480683Nov 4, 2010Jul 9, 2013Covidien LpFoam introduction system including modified port geometry
US8496581Mar 15, 2012Jul 30, 2013Applied Medical Resources CorporationSurgical access apparatus and method
US8540628Jan 13, 2011Sep 24, 2013Covidien LpExpandable thoracic access port
US8550992Sep 1, 2011Oct 8, 2013Covidien LpTwo-part access assembly
US8562641Sep 26, 2007Oct 22, 2013Covidien LpLaparoscopic instruments
US8574155Jan 13, 2011Nov 5, 2013Covidien LpExpandable surgical access port
US8579810Jan 13, 2011Nov 12, 2013Covidien LpExpandable thoracic access port
US8597180Jun 23, 2011Dec 3, 2013Covidien LpExpandable thoracic access port
US8602983Sep 2, 2011Dec 10, 2013Covidien LpAccess assembly having undercut structure
US8641610Sep 1, 2011Feb 4, 2014Covidien LpAccess assembly with translating lumens
US8647265Jan 14, 2011Feb 11, 2014Applied Medical Resources CorporationHand access laparoscopic device
US8652160Dec 11, 2009Feb 18, 2014Covidien LpLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US8652161Dec 11, 2009Feb 18, 2014Covidien LpLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US8657740Jan 27, 2010Feb 25, 2014Atropos LimitedInstrument access device
US8657741Aug 15, 2011Feb 25, 2014Atropos LimitedWound retractor
US8672839Sep 13, 2011Mar 18, 2014Applied Medical Resource CorporationSurgical access apparatus and method
US8690766Feb 12, 2013Apr 8, 2014Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US8696557Sep 1, 2011Apr 15, 2014Covidien LpAccess assembly including inflatable seal member
US8703034Aug 23, 2011Apr 22, 2014Applied Medical Resources CorporationMethod of making a tack-free gel
US8721537Jun 27, 2013May 13, 2014Applied Medical Resources CorporationSingle port access system
US8728109Feb 12, 2013May 20, 2014Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US8734336Apr 23, 2009May 27, 2014Atropos LimitedWound retractor device
US8740785Oct 19, 2010Jun 3, 2014Atropos LimitedWound retractor system
US8740904Nov 3, 2010Jun 3, 2014Covidien LpSeal anchor introducer including biasing member
US8747302Apr 15, 2013Jun 10, 2014Covidien LpLaparoscopic instrument and trocar system and related surgical method
US8753267Dec 6, 2011Jun 17, 2014Covidien LpAccess assembly insertion device
US8758236May 9, 2012Jun 24, 2014Applied Medical Resources CorporationWound retractor
US8764648Mar 15, 2013Jul 1, 2014Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US8764765Aug 31, 2009Jul 1, 2014Covidien LpLaparoscopic instrument and related surgical method
US8771311 *Dec 10, 2007Jul 8, 2014Jeder GmbhSurgical instrument and method for improving a crestal sinus lift
US8777849Jan 13, 2011Jul 15, 2014Covidien LpExpandable thoracic access port
US8795161May 18, 2009Aug 5, 2014Covidien LpButton port
US8795289Jun 10, 2013Aug 5, 2014Covidien LpFoam introduction system including modified port geometry
US8821390Feb 18, 2011Sep 2, 2014Covidien LpSurgical access method and assembly including sleeve and port
US8827901Jan 9, 2014Sep 9, 2014Covidien LpAccess assembly with translating lumens
US8864658Nov 16, 2011Oct 21, 2014Covidien LpExpandable surgical access port
US8870904Mar 12, 2012Oct 28, 2014Applied Medical Resources CorporationAccess sealing apparatus and method
US8876708Aug 13, 2008Nov 4, 2014Covidien LpLaparoscopic port assembly
US8888693Jul 1, 2011Nov 18, 2014Atropos LimitedInstrument access device
US8888695Mar 27, 2008Nov 18, 2014Covidien LpLaparoscopic port assembly
US8894571Apr 1, 2014Nov 25, 2014Applied Medical Resources CorporationSingle port access system
US8911365Aug 13, 2008Dec 16, 2014Covidien LpLaparoscopic port assembly
US8911366Jan 11, 2012Dec 16, 2014Applied Medical Resources CorporationSurgical access apparatus and method
US8932212Sep 22, 2010Jan 13, 2015Covidien LpSeal anchor with non-parallel lumens
US8932213Apr 9, 2014Jan 13, 2015Covidien LpSeal anchor with non-parallel lumens
US8932214May 11, 2011Jan 13, 2015Applied Medical Resources CorporationSurgical access system
US8961407Aug 31, 2009Feb 24, 2015Covidien LpSurgical port assembly
US8961408Nov 16, 2011Feb 24, 2015Covidien LpExpandable surgical access port
US8961409 *Dec 6, 2012Feb 24, 2015Covidien LpThoracic access assembly
US8961410Jan 6, 2012Feb 24, 2015Applied Medical Resources CorporationSurgical retractor with gel pad
US8968247Jun 10, 2013Mar 3, 2015Covidien LpLaparoscopic instrument and cannula assembly and related surgical method
US8973583Jun 26, 2012Mar 10, 2015Applied Medical Resources CorporationWound retractor
US8986202Aug 8, 2011Mar 24, 2015Atropos LimitedRetractor
US9011474Mar 15, 2013Apr 21, 2015Covidien LpLaparoscopic instrument and trocar systems and related surgical method
US9017250Apr 9, 2014Apr 28, 2015Covidien LpSeal anchor with non-parallel lumens
US9017251May 6, 2014Apr 28, 2015Covidien LpAccess assembly insertion device
US9017252Feb 18, 2011Apr 28, 2015Covidien LpAccess assembly with flexible cannulas
US9017254Jan 7, 2014Apr 28, 2015Applied Medical Resources CorporationHand access laparoscopic device
US9022926Sep 2, 2011May 5, 2015Covidien LpReinforced flexible access assembly
US9022927Apr 4, 2014May 5, 2015Covidien LpSurgical access method and assembly including sleeve and port
US9022928Mar 9, 2012May 5, 2015Covidien LpWound protector including balloon within incision
US9033873Feb 10, 2012May 19, 2015Covidien LpSurgical retractor including rotatable knobs
US9039610Apr 12, 2012May 26, 2015Covidien LpThoracic access port
US9039611May 1, 2014May 26, 2015Covidien LpLaparoscopic instrument and trocar system and related surgical method
US9078696Apr 5, 2012Jul 14, 2015Covidien LpSurgical retractor including polygonal rolling structure
US9084594Jan 8, 2013Jul 21, 2015The Board Of Trustees Of The Lealand Stanford Junior UniversityMethods for the prevention of surgical site infections
US9095300Oct 18, 2012Aug 4, 2015Atropos LimitedWound retractor device
US9101354Aug 29, 2012Aug 11, 2015Applied Medical Resources CorporationWound retractor with gel cap
US9113951Feb 20, 2012Aug 25, 2015Covidien LpSeal anchor for use in surgical procedures
US9119665Feb 16, 2012Sep 1, 2015Covidien LpThoracic access port including foldable anchor
US9161807May 23, 2011Oct 20, 2015Covidien LpApparatus for performing an electrosurgical procedure
US9168031Oct 30, 2013Oct 27, 2015Covidien LpExpandable thoracic access port
US9192366May 23, 2014Nov 24, 2015Applied Medical Resources CorporationWound retractor
US9241697Jun 19, 2014Jan 26, 2016Applied Medical Resources CorporationWound retractor
US9247955Jun 23, 2011Feb 2, 2016Covidien LpThoracic access port
US9259240Mar 5, 2012Feb 16, 2016Covidien LpArticulating surgical access system for laparoscopic surgery
US9271639Jan 31, 2013Mar 1, 2016Covidien LpSurgical introducer and access port assembly
US9271753Aug 7, 2003Mar 1, 2016Atropos LimitedSurgical device
US9277907Mar 12, 2014Mar 8, 2016Covidien LpAccess assembly including inflatable seal member
US9277908Feb 27, 2015Mar 8, 2016Atropos LimitedRetractor
US9289115Apr 18, 2013Mar 22, 2016Applied Medical Resources CorporationNatural orifice surgery system
US9289200Sep 30, 2011Mar 22, 2016Applied Medical Resources CorporationNatural orifice surgery system
US9295459Dec 18, 2014Mar 29, 2016Applied Medical Resources CorporationSurgical access system
US9307974Nov 5, 2013Apr 12, 2016Covidien LpAccess assembly having undercut structure
US9307975Jun 19, 2014Apr 12, 2016Applied Medical Resources CorporationWound retractor
US9307976Jan 27, 2014Apr 12, 2016Atropos LimitedWound retractor
US9314267Nov 21, 2014Apr 19, 2016Covidien LpLaparoscopic port assembly
US9351759Apr 12, 2012May 31, 2016Atropos LimitedInstrument access device
US9357910Jan 31, 2013Jun 7, 2016Covidien LpWound retractor including rigid ring
US9393005Jan 8, 2013Jul 19, 2016The Board Of Trustees Of The Leland Stanford Junior UniversitySystems for the prevention of surgical site infections
US9402613Apr 29, 2014Aug 2, 2016Covidien LpExpandable thoracic access port
US9408597Oct 7, 2013Aug 9, 2016Atropos LimitedInstrument access device
US9433435Jan 19, 2015Sep 6, 2016Covidien LpLaparoscopic instrument and cannula assembly and related surgical method
US20050059865 *Sep 17, 2003Mar 17, 2005Applied Medical Resources CorporationSurgical instrument access device
US20050241647 *Jun 3, 2003Nov 3, 2005Applied Medical Resources CorporationWound retractor
US20050288558 *Sep 1, 2005Dec 29, 2005Applied Medical Resources CorporationWound retraction apparatus and method
US20060030755 *Oct 5, 2005Feb 9, 2006Applied Medical Resources CorporationSurgical access apparatus and method
US20080027476 *Sep 26, 2007Jan 31, 2008Pnaval Systems, Inc.Laparoscopic instruments and trocar systems and related surgical method
US20080132765 *Dec 1, 2006Jun 5, 2008Beckman Andrew THand assisted laparoscopic device
US20080221389 *Mar 9, 2007Sep 11, 2008Beckman Andrew THand assisted laparoscopic seal assembly with deflection feature
US20080221483 *Mar 6, 2007Sep 11, 2008White William JHand assisted laparoscopic seal assembly with a ratchet mechansim
US20080221607 *Mar 6, 2007Sep 11, 2008White William JHand assisted laparoscopic seal assembly with a ratcheting mechanism
US20080255519 *Mar 27, 2008Oct 16, 2008Pnavel Systems, Inc.Laparoscopic port assembly
US20080319466 *Dec 10, 2007Dec 25, 2008Klaus EderSurgical instrument and method for improving a crestal sinus lift
US20090082632 *Sep 26, 2007Mar 26, 2009Voegele James WRotational control for a hand assisted laparoscopic seal assembly
US20090093682 *Oct 2, 2008Apr 9, 2009Tyco Healthcare Group LpSurgical portal with foam and fabric composite seal assembly
US20090093683 *Aug 20, 2008Apr 9, 2009Tyco Healthcare Group LpSurgical portal kit for use in single incision surgery
US20100100043 *Oct 14, 2009Apr 22, 2010Racenet Danyel JFlexible Access Device For Use In Surgical Procedure
US20100113886 *Aug 31, 2009May 6, 2010Gregory PiskunSurgical port assembly
US20100130825 *Dec 11, 2009May 27, 2010Gregory PiskunLaparoscopic instrument and trocar systems for transumbilical laparoscopic surgery
US20100130826 *Dec 11, 2009May 27, 2010Gregory PiskunLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US20100137691 *Dec 11, 2009Jun 3, 2010Gregory PiskunLaparoscopic instrument and trocar systems for trans-umbilical laparoscopic surgery
US20100222643 *Sep 2, 2010Tyco Healthcare Group LpLaparoscopic instrument and cannula assembly and related surgical method
US20100298646 *Apr 20, 2010Nov 25, 2010Tyco Healthcare Group LpFlexible access assembly with reinforced lumen
US20110040324 *Mar 17, 2009Feb 17, 2011Mccarthy Patrick MDevices and methods for percutaneous access, hemostasis, and closure
US20110054258 *Mar 3, 2011O'keefe Jonathan BFoam port introducer
US20110201893 *Aug 18, 2011O'prey CormacExpandable thoracic access port
US20110201896 *Aug 18, 2011O'prey CormacExpandable surgical access port
US20110251452 *Oct 13, 2011Davinci Biomedical Research Products Inc.Stoma stabilitating device and method
US20130018228 *Jul 13, 2012Jan 17, 2013Armstrong David NSurgical retractor device
US20130150681 *Jun 13, 2013Covidien LpThoracic access assembly
US20130184535 *Jan 8, 2013Jul 18, 2013The Board Of Trustees Of The Leland Stanford Junior UniversityExpandable tissue retraction devices
US20130225933 *Jan 22, 2013Aug 29, 2013Covidien LpAdjustable height port including retention elements
US20140114266 *Oct 22, 2012Apr 24, 2014Ams Research CorporationOstomy Implant System and Method
US20150119647 *Oct 24, 2014Apr 30, 2015Michael J. VaillancourtWound Protector
US20150126816 *Jan 14, 2015May 7, 2015Covidien LpThoracic access assembly
USD712033Jul 31, 2013Aug 26, 2014Covidien LpSeal anchor for use in surgical procedures
USD712034Jul 31, 2013Aug 26, 2014Covidien LpSeal anchor for use in surgical procedures
USD736921Jun 5, 2014Aug 18, 2015Covidien LpSeal anchor for use in surgical procedures
USD738500Jun 5, 2014Sep 8, 2015Covidien LpSeal anchor for use in surgical procedures
CN104125797A *Jan 8, 2013Oct 29, 2014里兰斯坦福初级大学理事会Methods and devices for prevention of surgical site infections
WO2011011538A3 *Jul 21, 2010Dec 11, 2014Applied Medical Resources CorporationSurgical access device comprising internal retractor
WO2013010107A2 *Jul 13, 2012Jan 17, 2013Cook Medical Technologies LlcSurgical retractor device
WO2013010107A3 *Jul 13, 2012Aug 22, 2013Cook Medical Technologies LlcSurgical retractor device
WO2013053926A2 *Oct 12, 2012Apr 18, 2013Neosurgical LimitedLaparoscopic system
WO2013053926A3 *Oct 12, 2012Jun 19, 2014Neosurgical LimitedLaparoscopic system
WO2014022094A1 *Jul 16, 2013Feb 6, 2014Rodriguez Carlos AndresFabric retraction device and method for minimally invasive surgery
WO2015014848A1 *Jul 29, 2014Feb 5, 2015Ernst-Moritz-Arndt-Universitšt GreifswaldHygiene drape for eye operations
Classifications
U.S. Classification606/191
International ClassificationA61B17/00, A61M29/00, A61B17/02, A61B19/00, A61B17/34
Cooperative ClassificationA61B2017/3492, A61B2017/3482, A61B90/50, A61B2017/00265, A61B17/0293, A61B17/3498, A61B17/3423, A61B2017/3405, A61B2017/3486, A61B2017/3484, A61B17/3462
European ClassificationA61B17/34H, A61B17/34G4A
Legal Events
DateCodeEventDescription
Jan 12, 2006ASAssignment
Owner name: APPLIED MEDICAL RESOURCES CORPORATION, CALIFORNIA
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNORS:HART, CHARLES C.;TAYLOR, SCOTT V.;REEL/FRAME:017469/0680;SIGNING DATES FROM 20030407 TO 20030411
Apr 26, 2012ASAssignment
Owner name: CITIBANK, N.A., TEXAS
Free format text: SECURITY AGREEMENT;ASSIGNOR:APPLIED MEDICAL RESOURCES CORPORATION;REEL/FRAME:028115/0276
Effective date: 20120417